Potassium

When high

For high potassium:

• Reduce potassium-rich foods and consult a physician

For high potassium (hyperkalaemia, >5.0 mmol/L):

• Identify and discontinue contributing drugs: ACE inhibitors, ARBs (telmisartan commonly used for TRT HCT/BP management), spironolactone, NSAIDs, potassium supplements; switch to amlodipine or nebivolol if antihypertensive still needed
• Patiromer (Veltassa) -- 8.4-25.2g/day oral; non-absorbed potassium binder; useful when ACE/ARB cannot be discontinued (e.g., heart failure)
• Sodium zirconium cyclosilicate (Lokelma) -- 5-10g/day; faster-acting potassium binder; useful for chronic hyperkalaemia
• Dietary restriction: limit bananas, potatoes, tomatoes, orange juice, dried fruit
• For acute hyperkalaemia (>6.0 mmol/L or ECG changes): emergency medical care; calcium gluconate, insulin/glucose infusion, sodium bicarbonate are standard in-hospital interventions
• Most athletes have normal potassium; extremes always warrant GP or cardiology workup rather than self-management

When low

For low potassium:

• Increase dietary intake: potatoes, sweet potatoes, avocados, bananas, spinach
• Electrolyte supplements

Pharmacological options:

For low potassium (hypokalaemia, <3.5 mmol/L) -- usually diuretic-induced in athletes:

• Potassium chloride (Slow-K, Span-K, Chlorvescent) -- 600-1200mg oral daily (8-16 mmol K+); modified-release tablets reduce GI irritation; prescription in most jurisdictions; recheck K at 1-2 weeks
• Spironolactone -- 25-50mg/day; potassium-sparing diuretic and aldosterone antagonist; useful when loop/thiazide diuretic cannot be discontinued; also has weak anti-androgen activity so avoid in men trying to preserve androgenic effects
• Amiloride -- 5-10mg/day; potassium-sparing diuretic without anti-androgen effect; preferred over spironolactone for men
• For severe hypokalaemia (<3.0 mmol/L) or with ECG changes: IV potassium replacement in hospital; do not attempt oral high-dose replacement without monitoring